Non-cancer related bilateral mastectomy pre-operative information sheet This leaflet explains more about non-cancer related bilateral mastectomy surgery, including the benefits, risks and any alternatives and what you can expect when you come to hospital If you have any further questions, please speak to a doctor or nurse caring for you. What is a non-cancer related bilateral mastectomy? A non-cancer related bilateral mastectomy is an operation to reduce the size of your chest by removing breast tissue. The chest is reshaped and in some cases the nipples are repositioned to provide a flatter chest to better suit your body. This is not an essential operation and the decision to have it depends on how you feel about the appearance of your chest. What are the risks? Bleeding. If you experience bleeding after leaving hospital apply firm pressure to the area for 15 minutes. If this cannot be stopped with firm pressure over the wound for 15 minutes, you should continue to apply pressure and go to the nearest Accident & Emergency Department. Wound breakdown. Small areas of the line of stitches may open up and produce fluid. This is common. If this occurs apply a simple dressing from a chemist. Then arrange to see your GP or make an appointment in the Plastic Dressing Clinic (PDC) whichever is more convenient in terms of time and distance. If you choose to go to your GP also then arrange an appointment in the Plastic Dressing Clinic so that any problems can be monitored. Infection. Signs include redness, swelling and discharge (oozing) from the wound and a raised body temperature. This can usually be successfully treated with antibiotics. Please contact your GP immediately you notice any of the above signs and arrange to bring forward your appointment with the hospital. If you are unable to contact your GP you should attend Accident & Emergency or the nearest Urgent Care Centre. Do not delay getting medical attention, as an infection can become life threatening if left untreated. Seroma formation. This is when fluid collects underneath the skin. Sometimes this needs to be drained using a syringe and needle. Alternatively it can be left to drain away naturally if it is not causing discomfort. Wearing a good supportive garment may help to reduce and/or control this. Altered sensation. You can expect some loss of feeling in the skin around the area of the operation. This numbness usually reduces in the following weeks, but sometimes this may last longer and can be permanent. Scars. These can become red and lumpy. Any scar takes a minimum of 12 months to settle. 1 of 5
There is a possibility that it will remain raised and noticeable. Once all areas have healed and the dressings are removed, you are advised to wash and dry the area normally. You should also moisturise and massage the scar twice a day with a non-perfumed cream (such as E45, 50/50 ointment, Diprobase, Vaseline Intensive Care). Nipple pigmentation. The nipple can often be hyper or hypo pigmented following this surgery (lighter or darker in colour) than before. This can sometimes change over time with moisturising and massaging or it may be a permanent change. Extra skin lumps. As the swelling reduces and the scars settle, you may notice small pyramids of additional soft tissue at the scar edges. These can be reduced with surgery at a later date under a local anaesthetic if required. The surgeon will talk to you about this at the follow up outpatient appointment. Are there any alternatives? This is not an essential operation and the decision to have it depends on how you feel about the appearance of your chest. How can I prepare for a non-cancer related bilateral mastectomy? Eat a well-balanced diet. Being at an optimum (ideal) weight helps your recovery. Your surgeon may have advised you to lose weight prior to the operation. Any diets to lose or gain weight should be discussed with your GP or dietician. Stop smoking. Smoking has a poor effect on healing so we advise you to take steps to give up smoking before the operation. Nicotine patches should not be used during the operative period or just after the operation. You may require a surgical chest binder. If your surgeon decides that you require a binder you will be expected to wear this for 24 hours a day for six weeks until the swelling and bruising subsides. It is a good idea to purchase a spare binder to enable you to alternate to a clean binder, wash your binders and ensure you have continual chest support. Bring a pair of pyjamas with a button-up top. This will make access to the wounds easier to access after your operation. We advise you make arrangements for help at home during your recovery. This will be for at least two weeks although some activities need to be reduced for 4 to 6 weeks including lifting and driving. Asking for your consent It is important that you feel involved in decisions about your care. Your surgeon will go through a consent form with you prior to surgery and you will be asked to sign a consent form to say that you agree to have the treatment and understand what it involves. You can withdraw your consent at any time, even if you have said yes previously. If you would like more details about our consent process, please ask for a copy of our policy. 2 of 5
What happens before and during a non-cancer related bilateral mastectomy? All information concerning your admission will be sent to you by post by the plastic surgery admission office. You are usually given two weeks notice before the operation date. You will have a general anaesthetic which means you will be asleep throughout the operation. Your operation usually takes between 2 to 4 hours. The types of incisions (cuts) vary from patient to patient and your surgeon will discuss with you what is best for you. The cuts are sealed with stitches and covered with dressings. The stitches are usually dissolvable but occasionally there will be some stitches requiring removal at some time after the operation. You will be fitted with below knee stockings to reduce the risk of developing a blood clot in your legs during surgery. The usual length of stay for this surgery is 2 to 3 days but this varies for each individual. You may leave the operating theatre with: A drain - one or more small tubes that allow excess fluid and blood to drain away from the operation site into plastic bottles. A drip - a small tube (cannula) inserted into a vein in your arm or hand to provide you with fluid until you feel comfortable to drink on your own. Medication can also be given this way as necessary. Will I feel any pain? Your chest may feel bruised, swollen and uncomfortable after the surgery. Make sure that you let the nursing staff on the ward know if you are in pain so that they can give you pain killers. When you go home you may need to take regular pain killers such as paracetamol and ibuprofen for the first couple of weeks until you feel more comfortable. What happens after a non-cancer related mastectomy? You will return to the ward to recover and will be offered something to eat and drink when you feel up to it. Your drip will be removed when you are drinking enough fluid. Drains are usually removed when the fluid draining reduces. This is usually within 24 hours. You will have dressings over the wounds and it is normally requested that these remain dry and intact for a week until your follow-up appointment at the Plastic Dressings Clinic based at St George s Hospital. You will usually be advised to wear a chest binder for the first six weeks post-operatively. This helps to reduce swelling and prevent fluid collections under the skin. 3 of 5
When you are fit to be discharged make sure that you have someone who can drive you home. Also make sure that you have a copy of your discharge summary, a contact number and any medications you have been given. What do I need to do after I go home? Make sure that you are wearing a well-fitting binder if your surgeon has told you this is required. This helps to control any swelling and prevent fluid collection under the skin. Remember you need rest for at least two weeks following this operation. Do not expect to be able to manage on your own as normal. You may need to arrange a relative or friend to help around the house. Do not carry out any heavy lifting for six weeks. This means children, vacuum cleaners, pots, pans, kettles, laundry and shopping bags. Avoid any sports/exercise for at least six weeks. This includes sexual intercourse. Do not drive for 4-6 weeks or until the wounds have healed and you have no pain. Do not return to work for at least four weeks. This will vary according to the type of job you do and your recovery. Keep moving around and take gentle exercise. Will I have a follow-up appointment? You will usually require a follow up appointment approximately 7-10 weeks after discharge with one of the nurses in PDC to check your wound progress and a follow up with your consultant 6-8 weeks later. These appointments will either be made before you leave the hospital, or given to you by post or by phone. If you have not received notification of your appointments within 3-4 days of your discharge please contact the plastic surgery appointments on 020 8725 5855 who can book this for you. Please note that you may require further follow ups in PDC but these will be arranged at your first PDC review. Useful sources of information https://www.nhs.uk/conditions/mastectomy/ https://www.nhs.uk/conditions/gender-dysphoria/treatment/ https://www.breastcancercare.org.uk/information-support/have-i-got-breast-cancer/benign-breastconditions/gynaecomastia Contact us If you have any questions or concerns about your non-cancer related mastectomy, please contact the plastic surgery dressing clinic nurses on 020 8725 0473 or the lead clinical nurse in plastic surgery on 020 8672 1071 and ask the operator to bleep number 6332 (Monday to Friday, 9am to 5pm). Out of hours, please contact Keate ward on 020 8725 3226 / 3227. For plastic surgery appointments, contact 020 8725 5855. 4 of 5
For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough Wing (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 Reference: PLS_NCBM_01 Published: March 2018 Review date: March 2020 5 of 5